- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.61 / $2,550.00 / $7,542.00
| Facility | | $554.61 | $2,550.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.98 / $448.18 / $683.08
| Professional | | $342.98 | $448.18 | $683.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,138.17 / $4,059.90 / $7,831.68
| Facility | | $2,138.17 | $4,059.90 | $7,831.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.27 / $446.82 / $723.17
| Professional | | $334.27 | $446.82 | $723.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $329.35 / $330.17
| Facility | | $80.00 | $329.35 | $330.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.32 / $614.32 / $614.32
| Facility | | $614.32 | $614.32 | $614.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.30 / $568.21 / $889.21
| Professional | | $383.30 | $568.21 | $889.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.52 / $11,500.00 / $16,394.00
| Facility | | $2,528.52 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,085.00 / $3,387.60 / $3,904.95
| Professional | | $3,085.00 | $3,387.60 | $3,904.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.99 / $511.50 / $850.64
| Facility | | $367.99 | $511.50 | $850.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.08 / $612.23 / $816.30
| Professional | | $465.08 | $612.23 | $816.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $250.00 / $250.00
| Professional | | $250.00 | $250.00 | $250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.33 / $514.00 / $880.78
| Facility | | $369.33 | $514.00 | $880.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.66 / $612.19 / $943.73
| Professional | | $400.66 | $612.19 | $943.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.00 / $4,100.00 / $8,226.00
| Facility | | $1,391.00 | $4,100.00 | $8,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.95 / $538.54 / $839.11
| Professional | | $404.95 | $538.54 | $839.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.05 / $437.11 / $614.53
| Professional | | $387.05 | $437.11 | $614.53 |